No-Fault Case Law

The court considered whether the defendant, State Farm Mutual Insurance Company, was entitled to summary judgment dismissing the complaint brought by Concourse Chiropractic, PLLC as the assignee of ODALIS GUZMAN to recover assigned first-party no-fault benefits. The main issues decided were whether the examination under oath (EUO) notices had been timely sent to the plaintiff, whether the plaintiff had failed to appear for the EUOs, and whether the defendant had demonstrated that the claims underlying these causes of action had been timely denied based on plaintiff's nonappearance at the EUOs. The holding of the case was that with respect to the first through sixth and ninth and tenth causes of action of the complaint, the defendant's motion for summary judgment was granted, as it had been established that the EUO notices had been timely sent to the plaintiff and that the plaintiff had failed to appear for the EUOs. However, with respect to the seventh and eighth causes of action, where it was undisputed that the defendant paid the claim underlying those causes of action but had failed to establish that its payment was timely, the motion for summary judgment was properly denied.

The court considered the requirements for submitting a claim for health service expenses under no-fault insurance benefits in New York. The main issue was whether the plaintiff had established a prima facie case for entitlement to the claimed amount of benefits. The court decided that the plaintiff failed to provide competent proof of the economic loss claimed, as the submitted evidence was not admissible to establish the facts asserted in the claim forms. Therefore, the court held that the plaintiff's motion for summary judgment on the complaint was denied, except as to a specific claim in a reduced amount, and remitted the matter to the lower court for further calculation and determination of the amount owed to the plaintiff for no-fault benefits.

The court considered conflicting medical expert opinions regarding the medical necessity of the diagnostic tests underlying the plaintiff's first-party no-fault claim. The main issue decided was whether the conflicting medical expert opinions raised a triable issue as to the medical necessity of the diagnostic tests. The court held that the conflicting medical expert opinions sufficed to raise a triable issue as to the medical necessity of the diagnostic tests underlying the plaintiff's first-party no-fault claim. Therefore, the court affirmed the order of the Civil Court of the City of New York, Bronx County, which denied the defendant's motion for summary judgment dismissing the complaint.

The court considered the failure of the defendant to attend scheduled Independent Medical Examinations (IMES) as a basis for denying all of the defendants' claims for No-Fault benefits from the plaintiff insurance company. The defendants attempted to defeat the motion on the grounds that it was premature, the plaintiff failed to prove that letters were sent to the defendant, and that the plaintiff disclaimed too late. The court held that in order to defeat a motion for summary judgment, the defendant must come forward with legally admissible evidence, which the defendants failed to do in this case. The court also ruled that a late declining of coverage will not uphold rejection when the assignor has failed to appear at designated IMES, and awarded summary judgment against the answering defendants and default judgments against the non-appearing defendants. Therefore, neither defendant Miranda nor any of her assignees may recover from the insurer American Transit Insurance Company for the accident that occurred on December 8, 2008.

The main issues in this case were whether the Civil Court of New York had obtained jurisdiction over a defendant insurance company, and if the plaintiff was entitled to discovery to determine if there was proper jurisdiction. The defendant had submitted a certificate of conformity and an affidavit stating that they did not conduct business in New York, while the plaintiff argued that the certificate of conformity was inadmissible. The court ruled that the plaintiff had the burden of proving that jurisdiction had been properly obtained, and since the plaintiff failed to show that the defendant had any contacts with the City of New York, the Civil Court properly dismissed the complaint. Therefore, the order granting the defendant's motion to dismiss the complaint was affirmed.

The relevant facts considered by the court were that Westchester Medical Center, as the assignee of Gerard R. Brown, was seeking to recover first-party no-fault insurance benefits from New South Insurance Company. The main issue decided was that the District Court denied Westchester Medical Center's motion for summary judgment. The holding of the case was that the District Court properly determined that Westchester Medical Center was not entitled to summary judgment, as it had failed to establish the absence of a material issue of fact. The appellate court affirmed the order, without costs, and declined New South Insurance Company's request to award it summary judgment dismissing the complaint.

The court considered Interboro Insurance Company's motion for leave to enter a default judgment against all defendants and the cross motion of defendants-respondents KHL Acupuncture, P.C. and South Shore Osteopathic Medicine, P.C. to compel acceptance of their answers. The main issue decided was whether no-fault insurance coverage exists solely based on defendant Perez's failure to appear for an examination under oath (EUO). The holding of the court was that the motion court properly exercised its discretion in granting defendants-respondents' cross motion to compel plaintiff to accept their belated answers. It was also found that a meritorious defense is not required to obtain relief under CPLR 3012 (d). Furthermore, there was insufficient evidence that defendant Perez was properly notified of the EUOs, thus the motion court also properly denied plaintiff's motion for a default judgment.

The relevant facts the court considered involved a plaintiff seeking to recover first-party no-fault benefits under an insurance policy issued by the defendant. The plaintiff alleged that they had timely notified the defendant of an accident, but the defendant failed to pay the bills. The defendant moved to dismiss the complaint for failure to state a cause of action, arguing that the complaint was insufficient to state a claim of indebtedness. The main issue decided was whether the complaint stated a cognizable cause of action and gave the defendant notice of the transactions intended to be proved. The holding of the court was that the complaint was afforded a liberal construction and was determined to state a cognizable cause of action, and therefore the judgment to grant the defendant's motion to dismiss the complaint was reversed and the motion was denied.

The relevant facts the court considered were that the plaintiff commenced an action in 2006 to recover assigned first-party no-fault benefits, and the defendant defaulted. More than a year later, the plaintiff moved for leave to enter a default judgment, which was granted by the Civil Court. The main issue decided was whether the default judgment and the underlying order granting the plaintiff's motion should be vacated, and whether the complaint should be dismissed. The holding of the case was that while the defendant failed to demonstrate that the default judgment should be vacated pursuant to CPLR 5015 (a) (3), the dismissal of the complaint was required pursuant to CPLR 3215 (c) as the plaintiff failed to offer any excuse for its delay in moving for leave to enter a default judgment. Furthermore, the court exercised its inherent discretionary power to vacate judgments in situations that warrant vacatur but were not specifically codified in CPLR 5015 (a), and therefore granted defendant's motion to vacate the default judgment and dismiss the complaint.

The court considered the fact that plaintiff's assignor, a New Jersey resident, was injured in a motor vehicle accident. The vehicle was insured by a New Jersey automobile insurance policy issued to the assignor, which was to be interpreted "pursuant to the laws of the state of New Jersey." Plaintiff, a New York business entity, rendered medical services to the assignor in New York and submitted claims to defendant. Plaintiff subsequently commenced this action, alleging that payment of no-fault benefits on the 10 claims it had submitted to defendant was overdue and moved for summary judgment. In opposition to plaintiff's motion, defendant argued that New Jersey law controlled and that, under New Jersey law, plaintiff had failed to establish its prima facie entitlement to summary judgment. The main issues decided were whether the insurance policy provided for mandatory arbitration, and whether plaintiff was entitled to recover no-fault benefits. The holding of the case was that the insurance policy did not provide for mandatory arbitration, and the plaintiff failed to establish the medical necessity of the rendered services and failed to show that the defendant did not properly pay any claim within 60 days. As a result, the judgment was reversed, the motion for summary judgment was denied, and defendant's cross motion was granted.